A Cheat Sheet to the Senate Health Bill’s CBO Score
On Monday, the Congressional Budget Office released its score of the Senate Republicans’ version of a health care bill, christened the Better Care Reconciliation Act. The score was not good. The White House, rather than defend the substance of the bill, moved quickly to cast doubt on the CBO’s evaluation. The score, which can be read in its table-filled entirety here, can be for those not practiced in budgetary and health-policy analysis a bit opaque. We’ve pulled a few salient details from the report, as well as related analysis from Congress’ Joint Committee on Taxation, and listed them in the following graphic.
There Are Two Countries That Prefer Trump to Obama. Take a Wild Guess.
If America is great again, the world—with one or two exceptions—doesn’t seem to know it yet. The Pew Research Center released a new report today comparing views of the United States and the U.S. president from around the world to the same from the end of the Obama era. The results aren’t exactly surprising, but they certainly are dramatic.
The survey of 37 countries taken between the end of February and beginning of May found a drop of 64 to 49 percent in those with a favorable view of the U.S. since the end of the Obama presidency. Those with an unfavorable view increased from 26 percent to 39 percent. As for Trump, the number of people with confidence in the U.S. president fell from 64 to 22 percent, while those with no confidence increased by 22 percent to a whopping 74 percent.
While the difference is most stark in Western Europe, 35 of the 37 countries surveyed had a lower opinion of Trump than Obama:
About those outliers: Obama, who had a contentious relationship with Prime Minister Benjamin Netanyahu, was widely disliked in Israel. The Trump administration has had a couple of missteps in the relationship already, but its hard line against Iran and an approach to the peace process that’s deferential to Israel even by normal U.S. standards, seems to have pleased Israelis.
As for Russia, there were high hopes there—for obvious reasons—that the Trump administration would pursue a more pro-Russian foreign policy. It hasn’t quite turned out that way on a range of issues, from sanctions to Syria policy, and the pro-Kremlin media has reportedly become much more critical of the U.S. president. In other words, the good feelings may not last much longer.
The Senate Health Care Bill Is Stalled. What Now?
The Better Care Reconciliation Act is theoretically one or two days away from its first, crucial procedural vote. Senate Majority Leader Mitch McConnell needs 50 votes to proceed. So who, especially after the Congressional Budget Office’s latest grim analysis of a Republican attempt to reform the health care system, is going to vote for this thing?
The rank-and-file—which in this case means senators who don’t really care about or understand health care—will do what is expected of them, though not because they’re particularly thrilled about the impending health care utopia they’ve been promised. I asked Alabama Sen. Richard Shelby, for example, what he made of the CBO report.
“Well, it’s interesting,” he said. “Saving a lot of money!”
Good old Dick Shelby will vote for it. So will Oklahoma Sen. Jim Inhofe, who told a reporter that he’s “not sure what [the bill] does,” but that he knows it’s “better than Obamacare.” Arizona Sen. John McCain would like to see “a lot” changed but isn’t withholding his support because, he said, “that’s not how it works.” (Oh?) South Carolina Sen. Lindsey Graham, similarly, will be there when he’s needed, but he couldn’t help but notice the damage that the CBO’s projection of 22 million fewer insured—along with the immediate premium increases, and higher out-of-pocket costs—does to the bill’s prospects.
“The bottom line,” he said, “is you’re probably not going to get 49 [votes]. You’re probably going to get 50 or probably 35.”
So then what is going to be done in the next 24 or 48 hours to get those 50 votes that are needed to open debate on the bill?
Nevada Sen. Dean Heller said that he would vote no on the motion to proceed to debate in a press conference Friday, and that it would be “very difficult” to get him to yes. Rand Paul, who seems completely gone, told reporters Monday night that he would “absolutely” vote no on the motion to proceed unless the bill is remade to his liking, an overhaul that would probably earn one total vote in the Senate. Wisconsin Sen. Ron Johnson reiterated Monday that he probably wouldn’t vote for it, either, barring some major changes. He’s considered one of the more easily “gettable” holdouts, along with Texas Sen. Ted Cruz, who deflected several questions Monday about how he would vote on a motion to proceed.
Maine Sen. Susan Collins told reporters as she was entering the Capitol that she would have a statement out soon with her reaction to the CBO score, but that the score is “obviously not positive.” She later tweeted out a statement: She would vote no on the motion to proceed, because the CBO score confirmed that BCRA is hot garbage.
I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won't do it. I will vote no on mtp. 1/3— Sen. Susan Collins (@SenatorCollins) June 26, 2017
CBO says 22 million people lose insurance; Medicaid cuts hurt most vulnerable Americans; access to healthcare in rural areas threatened. 2/3— Sen. Susan Collins (@SenatorCollins) June 26, 2017
Senate bill doesn't fix ACA problems for rural Maine. Our hospitals are already struggling. 1 in 5 Mainers are on Medicaid. 3/3— Sen. Susan Collins (@SenatorCollins) June 26, 2017
There are now more than enough votes to block the motion to proceed, split about evenly with complaints from the moderate and conservative perspectives. The bill is stalled—and we haven’t even heard from other votes like Ohio Sen. Rob Portman, West Virginia Sen. Shelley Moore Capito, Colorado Sen. Cory Gardner, Alaska Sen. Lisa Murkowski, and others who have expressed discomfort with the prospect of voting for hot garbage. The Wednesday vote on the motion to proceed, to put it generously, looks ambitious.
This comes down to what health care really means to Mitch McConnell. If he is determined to pass a health care bill, he could call off the vote and work through July toward reaching consensus. If he’s ready to move on, he could call off the motion to proceed, end the effort, and blame Democrats indefinitely for everything that’s wrong with American health care.
Or this could all be posturing, and hot garbage will get 50 Senate votes on Thursday.
Today's Impeach-O-Meter: The Health Care Bill Is Bad
In the tradition of the Clintonometer and the Trump Apocalypse Watch, the Impeach-O-Meter is a wildly subjective and speculative daily estimate of the likelihood that Donald Trump leaves office before his term ends, whether by being impeached (and convicted) or by resigning under threat of same.
My colleague Jordan Weissmann described one part of the Senate health care bill as "political suicide" shortly before the Congressional Budget Office issued its score on the proposal Monday. The CBO's analysis—that the bill would cause 15 million people to lose or drop their insurance in 2018, a number that would rise to 22 million by 2026—is not going to help on that front, and moderate Maine Sen. Susan Collins has already announced in pretty strong language that she won't vote for it as is. Collins, Nevada Sen. Dean Heller, and Kentucky Sen. Rand Paul (who objects that the bill is too generous) are hard enough "no" votes that it's looking like GOP leadership's plan to rush the legislation through before the Fourth of July may not work out.
The Republicans' plan with health care was seemingly for the Senate to come up with a bill that seemed moderate in comparison to the House's American Health Care Act—one whose consequences wouldn't kick in for many years, and which could get rushed through without too much backlash. The CBO's estimate of major and immediate coverage losses is thus bad news for them, and Donald Trump's chances of being ultimately forced (by a Democratic Congress) to pay a price for his many crimes thus rises accordingly.
CBO Says 22 Million Will Lose or Drop Insurance in Next Decade Under Senate Health Care Bill
The Congressional Budget Office analysis of the Senate health care bill has arrived. Your topline takeaways:
- The CBO estimates that 15 million more Americans would be uninsured next year, 2018, under the Senate bill than would be uninsured under existing law (i.e. the Affordable Care Act). However, the analysis notes that this is "primarily because the penalty for not having insurance"—the individual mandate—would be eliminated under the draft of the Senate law that the CBO evaluated. (Young and/or generally healthy individuals would thus have less of an incentive to cover themselves.) A so-called "lock out" mechanism that would replace the mandate is being added to the bill; Slate's economics columnist described it as "politically suicidal," so there's that*.
- Speaking of political suicide, because the bill also eliminates the mandate that certain employers cover their employees, the CBO estimates that four million individuals who currently have employer-provided insurance will lose it next year.
- By 2026, the estimate says, 22 million fewer Americans will be uninsured than would have been under current law. That total end number, the CBO says, would be attributable in part to "lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market," a.k.a. the Obamacare exchanges.
- Says the CBO: "By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent." An estimated 4 million Americans would lose Medicaid coverage next year.
- The CBO estimates that the bill cuts $771 billion in Medicaid spending and $408 billion in exchange-subsidy spending. It also includes the elimination of $172 billion in taxes on individuals who earn more than $200,000 a year.
- In broad terms, the bill would cause the average premium to rise across the board in the near term, then fall in the long term—but only because deductibles will rise accordingly and because old and/or sick individuals will find coverage to be so expensive that they end up not buying into the market. "Most people purchasing [insurance on the Obamacare exchanges] would have higher out-of-pocket spending on health care than under current law," the CBO writes. Our aforementioned economics/health care specialist describes it like so: Under the Senate bill, "The young pay slightly less, the middle-aged pay the same, and the old pay immensely more."
More to come on this story tonight and in the coming days!
*Correction, June 26: This post originally suggested a six-month lockout penalty wasn't included in the CBO analysis. It was.
Everything You Could Possibly Want to Know About the State of the Senate Health Care Bill Is in This Post
Ahoy! Here's what has happened with the Senate's health care/tax cut bill since it was made public last week. (Click that link for a quick overview of the bill itself.)
We haven't yet gotten a Congressional Budget Office estimate of how many Americans will lose (or choose not to pay for) insurance coverage because of the bill. Politico's sources guess that the number will be somewhere between 15 million and 22 million. (The House bill's CBO uninsured estimate is 23 million.) The CBO score is expected to be issued later Monday.
Where Votes Stand
There appears to be actual significant uncertainty as to whether the bill will pass. The insider Axios site reports that a member of Majority Leader Mitch McConnell's staff "has been telling associates that there's a 60 percent chance he can pass the bill," but notes that others in McConnell's camp "say it's more like a jump ball."
No Democrats are planning to vote for the bill, so Republicans need 50 of the 52 members of their caucus to vote "yea" (or "yes" or "OK, fine") in order to pass it with a tie-breaking vote by Mike Pence. Sens. Rand Paul (Kentucky), Mike Lee (Utah), Ted Cruz (Texas), and Ron Johnson (Wisconson) are currently holding out because they believe the bill doesn't go far enough to repeal Obamacare; consensus seems to be that Cruz and Johnson will eventually come around but that Paul and Lee might not. Sens. Susan Collins (Maine), Lisa Murkowski (Alaska), Dean Heller (Nevada), Shelley Moore Capito (West Virginia), Rob Portman (Ohio), and Bill Cassidy (Louisiana) are known to be undecided or opposed because the bill's Medicaid cuts would hurt their rural and/or low-income constituents. (Collins and Murkowski also have concerns about cuts to Planned Parenthood funding.) Conservative-but-unpredictable Nebraska Sen. Ben Sasse also refused to say whether he supports the bill over the weekend.
It's also possible that all of this is a charade made out of smokescreens and that the bill is going to pass easily once a few buyoffs/tweaks are made.
When They're Voting
After some rumblings that a vote on the legislation could be held as late as Aug. 1, Senate whip John Cornyn, R-Texas, now says a vote will be held this week. The thinking appears to be that Republicans will suffer less of an immediate political hit for passing the (unpopular) legislation now than they would if weeks of media coverage—and a long Fourth of July recess that members will likely spend in their home states—gave constituents time to get riled up about it. (Democracy!)
(Incidentally, the New Republic has an interesting idea as to how Democrats could take advantage of this short time frame and moderate Republican wobbliness by trying to convince some of the undecided moderates to form a "working group" with centrist Democrats—such as West Virginia's Joe Manchin and North Dakota's Heidi Heitkamp—to write an alternative bill. Said group would give members cover in their home states by demonstrating that they were making an earnest reform effort—and the time it would take to write it would also likely run out the clock on the current, more draconian proposal.)
Democrats don't have a lot of other options as far as #resisting the bill goes, since Republicans plan on passing it through the 50-vote budget reconciliation process. Progressive activists are, however, planning to form a human ring around the Capitol in a Wednesday demonstration that's intended to, yes, pressure wobbly GOP moderates.
New Stuff in the Bill
The initial draft of the Senate bill eliminated the Obamacare "individual mandate" requiring Americans to purchase insurance but didn't replace it with any similar measure. Since a functioning insurance market requires healthy and sick individuals to pay in, this would've caused the proverbial skyrocketing premiums. So Republicans have amended the bill to include a "lock out" penalty, which incentivizes "continous coverage" by prohibiting individuals who drop their insurance plans (or are dropped from them involuntarily and are temporarily unable to join a new plan) from buying new insurance for six months.
I am not a highly paid strategy consultant, but it seems to me like penalizing people who lost their insurance and couldn't afford new coverage is not a winning "look" politically and will not help this bill pass, especially when combined with the incoming CBO score. But then again, I didn't think Donald Trump would win the election last year. So maybe I can go right to hell!
The Latest Kushner Scoop Shows Just How Difficult Robert Mueller’s Job Is
The Washington Post kicked off the week with a long look at the latest shady-seeming financial dealings of the Trump clan: a $285 million loan Jared Kushner’s family business, Kushner Companies, received from Deutsche Bank the month before the 2016 election. The story adds more dots to an already crowded canvas of Trump-themed conflicts of interest and loose links with Russia, but doesn’t draw a line between any two of them in permanent marker. A quick rundown:
Theresa May’s New Partnership Allows Her to Stay in Power. But What Will It Mean for Brexit?
Prime Minister Theresa May’s Conservative Party will remain in power in Britain, following its disastrous election result earlier this month. May’s position, however, is severely weakened, and she has an unexpected and controversial new partner to deal with.
On Monday, the Tories, who were left nine seats short of a majority in parliament by the election, announced a partnership deal with Northern Ireland’s Democratic Unionist Party, or DUP, which controls 10 seats. Rather than a coalition government, in which the smaller party would get positions in May’s cabinet, the deal is a loose “confidence and supply” arrangement under which the DUP has agreed to support the Conservatives on key votes allowing them to stay in power. In this case, the DUP has agreed to support May on legislation related to Britain’s negotiations on leaving the European Union. In exchange for the DUP’s support, May agreed to an additional $1.3 billion in funding for Northern Ireland.
So what is the DUP? It’s Northern Ireland’s main Protestant, unionist party, meaning that it favors maintaining strong ties to the United Kingdom. While it has virtually no support outside Northern Ireland, where it’s narrowly the largest party, it does compete for seats in the U.K. Parliament, where it would normally have relatively little influence. While it has moderated its positions since the days when it was led by founder, Protestant activist, and hard-line anti-Catholic preacher Ian Paisley, it’s still a controversial partner for the prime minister.
For one thing, the DUP is very socially conservative by the standards of British politics. It opposes both abortion and same-sex marriage and its lawmakers have made some very homophobic remarks in recent years. Northern Ireland is the only country in the United Kingdom where same-sex marriage is illegal and abortion is highly restricted. The new arrangement is unlikely to have an impact on those policies on the British mainland, but the Conservative-DUP partnership is still a disappointment for the British LGBTQ rights movement: The Tories have become much more liberal on gay rights in recent years, and it was David Cameron’s Tory government that introduced marriage equality.
It’s also unclear what impact the deal will have on the fragile peace process in Northern Ireland. The DUP’s main rival—the Catholic, Irish nationalist Sinn Fein—is hoping that in a post-Brexit world, with so much else up for grabs, it might now be possible to revisit the issue of Northern Ireland leaving the United Kingdom to become part of the Republic of Ireland. As part of the deal, May’s government has given the DUP assurances that it believes that “Northern Ireland’s future is best served within a stronger United Kingdom” and that it would oppose changes to that agreement. This probably means no referendum on Irish unity for the time being. Sinn Fein is also now arguing that the British government can no longer be a neutral arbiter in Northern Ireland’s contentious power-sharing talks, given the ruling party’s partnership with their rival.
Outside of Northern Ireland, the big question about the deal is what it will mean for Brexit negotiations. The DUP supports Brexit, but that support probably has limits. Though the DUP’s Protestant base skews Euroskeptic, Northern Ireland as a whole voted “remain” in last summer’s referendum—not surprising given its close links to the Republic of Ireland. Even with their loyalties to London, economic realities on the island mean that the DUP is likely to oppose a Brexit scenario that saw a complete loss of access to European markets or—the most dramatic scenario—the resumption of border controls between the republic and Northern Ireland.
In her public statements, May has indicated she favors a “hard Brexit” scenario, prioritizing immigration controls and rolling back EU regulations over maintaining ties to European markets. She has stated that “no deal is better than a bad deal,” meaning that she’s open to a complete break with the EU without a partnership agreement to replace it. After this month’s election—a vote that she misguidedly called in order to strengthen her position in negotiations—and this resulting new partnership, that hard line has become a lot less tenable
Supreme Court Allows Trump’s Travel Ban to Take Effect—but Only in Part
On Monday, the Supreme Court allowed Donald Trump’s travel ban to take effect, but only in part. The court’s per curiam decision found that the lower courts’ preliminary injunctions, which fully halted the key provisions of the executive order, were too broad. So the court narrowed these injunctions, ruling that the travel ban “may not be enforced against foreign nationals who have a credible claim of a bona fide relationship with a person or entity in the United States.” However, “all other foreign nationals are still subject to the provisions” of the order. The court also set arguments on the merits of the case for the first day of its next term—that is, early October.
In practical terms, Monday’s ruling is a qualified but significant victory for the Trump administration. The court dramatically limited the scope of the injunctions below, which had blocked the two central components of the order: One barring citizens of six Muslim-majority countries from entering the country, and another halting the refugee resettlement program while halving its size. The government may now exclude citizens from those six countries from coming into the United States unless they have some meaningful connection with a “person or entity” in the country. That rule presumably encompasses foreign nationals who have family members in the U.S., or those who are enrolled in American universities, but its scope isn’t clear at all; the issue may well be litigated.
The court’s order also allows the government to exclude refugees—even those who are already vetted and poised to resettle here—unless they have the required U.S. connections. Moreover, the government can lower the cap on refugees who enter this year, from 110,000 to just 50,000. But it may not exclude refugees with relations in the U.S., even if “the 50,000-person cap has been reached or exceeded.” These compromises ensure that tens of thousands of refugees will remain stranded abroad despite prior assurances from the government that they would soon be resettled in the United States.
Russia Recalls Ambassador Who Is at Center of Trump Collusion Investigations
Russian Ambassador to the United States Sergey Kislyak is leaving Washington. The controversial diplomat will end his decadelong stint, according to BuzzFeed News, which confirmed the move with “three individuals familiar with the decision.” Although his date of departure has not been confirmed, the U.S.–Russia Business Council will be hosting a going-away party for Kislyak on July 11.
Kisyak is leaving at a time when several investigations are looking into possible collusion between the Trump campaign and the Kremlin, including several conversations the ambassador had during and after the presidential campaign. Several top officials in President Donald Trump’s administration have faced questions about undisclosed meetings they had with Kislyak, including former National Security Adviser Michael Flynn, top adviser Jared Kushner, and Attorney General Jeff Sessions. Last week, Newsweek described Kislyak as “the most radioactive man in Washington.”
“He could use some time away,” a U.S.–based diplomat told BuzzFeed.
One of the key questions surrounding Kislyak involves a meeting he had with Trump’s son-in-law in December. After the meeting, Kislyak allegedly told Moscow that Kushner had requested a secret channel of communications with the Kremlin. Kislyak was also at the White House when Trump revealed classified information to Russian Foreign Minister Sergey Lavrov in May.
Despite all this controversy though, Kislyak has not shied away from the public eye in recent months and “has remained a prominent fixture in Washington’s diplomatic party circuit,” notes BuzzFeed. Russian media has reported that Deputy Foreign Minister Anatoly Antonov has been appointed as the new ambassador to the United States but still has to be approved by Russia’s parliament.